Gonorrhea

Gonorrhea is the most frequently reported communicable disease in many of the more developed countries. Rates are 5–50 times higher than in the less developed world. The Gram-negative coccus that causes the disease is called Neisseria gonorrhoeae. It is a highly specialized organism that requires a mucosal surface to gain access to the body. The most important health consequence of gonorrheal infections is fallopian tube damage and the associated predisposition to ectopic (tubal) pregnancies and infertility.

In men, urethritis is the most common clinical manifestation of gonorrhea. Symptoms include dysuria and/or a purulent urethral discharge. Complications of gonorrhea are uncommon in men, but urethral stricture, epididymitis and prostatitis can occur. Between 20 and 30% of heterosexual men with symptomatic gonococcal urethritis are simultaneously infected with Chlamydia trachomatis.

Gonococcal infection in women is often asymptomatic. Morbidity associated with the infection, however, is far greater than that seen among infected men. A significant number of women diagnosed with gonorrhea are identified in sexually transmitted disease (STD) clinics as the asymptomatic consort of an infected partner. Uncomplicated urogenital gonococcal infection in women may present as dysuria from urethritis, vaginal discharge from cervicitis, or purulent drainage from the Skene or Bartholin glands at the vaginal introitus. Pelvic inflammatory disease (PID) is a term used to describe infection of the upper genital tract, including endometritis, salpingitis and peritonitis. Neisseria gonorrhoeae and C. trachomatis are the two pathogens most commonly isolated from women with positive cultures for PID. Women with gonococcal PID present with lower abdominal pain, abnormal uterine bleeding, dyspareunia (pain with intercourse) and fever. Although mortality from PID is low, morbidity is extremely high. PID is an important risk factor for chronic pelvic pain, infertility and tubal pregnancies. In some areas of Africa, up to 50% of women are infertile as a result of tubal occlusion from gonococcal PID.

Other serious clinical manifestations include disseminated gonococcal infection (DGI) and gonococcal ophthalmia neonatorum, a severe form of conjunctivitis affecting newborn infants who acquire the infection in the birth canal. Neonatal gonococcal ophthalmia can result in blindness if left untreated. It is a rarity in developed countries because neonatal ocular prophylaxis is mandated at birth, but remains a significant problem in many resource-poor parts of the world.

Gonorrhea is treated with antibiotics. Due to antibiotic resistence profiles, a parenteral cephalosporin plus doxycycline or azithromycin is currently first-line therapy for uncomplicated infections, but the choice of antibiotic evolves with resistence profiles and the propensity for the organism to be associated with other STDs.

Stay updated, free articles. Join our Telegram channel

Join